FEMA-EC96021402/14/~? 15:54 G & ~ CONSULTANTS, INC. -* 972304~514 ~02
ELEVATION CERTIFICATE
FEDERAl- EMEItGENCY MANAGEMENT AGENCY
NATIONAl. Fl-GOD INSUI~U~ICE PROGRAM
ATTENTION; Uae of thi~ ce~fflcafe do# not provide a waiver of the flood Insurance purcheae rm3,uirement. This lorm is U~KI only tO
provide elevation Information neces,ry to e~ure compliance with applicable community flooO~in management ordinances, to
determine the proper inaurance premium rate, end/or to supllx~ a request for a L,eiter of Map Amendment or Revision (LOMA or LOMR).
Irlltruct~rm ~gf oeml)fltlng thio fe~n c~n be k~nd an the following pelII.
fICTION A PINOFEFITY INFMIMATION
i
Nu~, O~ PO. ~OUTE ~0 SOX NUWE~ t CC~P~N~-~ ~U---~'~
STATE ZiP COOE
Provide me tollowing from the proper FIRM {See Instructions):
7. Indicate the elevation (latum system use<l on the FIRM tot Base ~lood Elevatlona (8FE): ~<IGVD '29 ~-~ Othe (d ecri )
8. For Zones A or V, where no BFE is provided m the FIRM, and the community has established a BFE for Mis I~llaing site, indicate
I I ~ teat NGVD (or other FIRM datum--see Section B, item 7)
the community's BFE:i i :
ECTION C BUILDING ELEV&TION INFORMATION
1. Using the Elevation Certilicate Instructior~, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
damE;ribes the s~,~13ject I:~,dlding's reference level jr ...
2(a). FIRM Zones Al-A30, AE, AH. and A (with BFE). The lop of the reference level floor from the selected diagram is at an elevation
of L_[._L~>-~-.L~ feet NGVD (or Other FIRM datum-see Section 8, Item 7).
b). FIRM Zones V1-V30, YE, and V (with BFE). The bottom of the lowest h~rizontel structural member of the reterenoe level from
the selected diagram, is at an elevation of L__L_t_. L, L~-~ .. ·: teat Nord (or other FIRM daturr~see Section B, Item 7).
c}. FIRM Zone A (without BFE), The floor used as the reference level trom the selected atagrem is [_. [_; :_ .! fee~ aox)ye 1'_~.~ or
below ~.-'~., (check one) the highest grade adjacent to the building.
d). FIRM Zone AG. The floor used as the reference level from the selected diagram is __L_. _! feet above ~ or below ~ (check
one) the highest grade adjacent to the building, tf no flood del~h number is available, i$ the building's lowest floor (reference
level) elevated in ~ccord~nce with the community's flood~eln management o~dinence? F-- Yes ~ No I r .~
Unknown
3. Indicate the elevation datum system used in determining the at~ve reference level elevel~ons: ._ NGVD '29 ~':.i Other (al#cribs
un, er Con~rf~4~ts on Page 2). (NOTE: It the elevati~q datum t/led In measuring ~he elevations is different ~han tflat used on
the FIRM [see Section B, Item 7], then convert the elevatior~ to the datum system used on ~he FIRM and ~how the conversion
equation under Comments on Page 2.)
4. Elevation reference mark used al3gears on FIRM: [-'~es ~ No (See Instructions on Page 4)
5. The reference level elevation is baaed on: [] actual construction ~ construe'lion dr~wlngs
NOTE: Use of construction drawings is only valid g the building does not yet have the reference level floor in place, in wfllch
case this cartel~catew~# onlybevalidforthebuildingduringthecourSeo! construction. Apo~t-con~trucfionElevationCertificate willberequired onceconstrucflotl1~ complete.)6, Theelevationofthelowestgradeimmediatelyadjacentto thebuildingis: [_. J-~ ,IlfeetNGVD (orotherFiRMdatum-seeSectionB, Item7).CNG. ocomu.r1. Iftt~ communityofficialre%oor~bte forvedlytngbuildingelevalJonsIri3ecitJesthat ~ refererlceleveli~t~ in ~nC, Item1fl~" ~ dMin~ bythe ~i~ il: ~.~ .LJfat ~vo (or ~rFIRM ~m~see